Development and validation of the Chinese Geriatric Depression Risk calculator (CGD-risk): A screening tool to identify elderly Chinese with depression

Background: The prevalence of depression among China's elderly is high, but stigma surrounding mental illness and a shortage of psychiatrists limit widespread screening and diagnosis of geriatric depression. We sought to develop a screening tool using easy-to-obtain and minimally sensitive predictors to identify elderly Chinese with depressive symptoms (depression hereafter) for referral to mental health services and determine the most important factors for effective screening.Methods: Using nationally representative survey data, we developed and externally validated the Chinese Geri-atric Depression Risk calculator (CGD-Risk). CGD-Risk, a gradient boosting machine learning model, was eval-uated based on discrimination (Concordance (C) statistic), calibration, and through a decision curve analysis. We conducted a sensitivity analysis on a cohort of middle-aged Chinese, a sub-group analysis using three data sets, and created predictor importance and partial dependence plots to enhance interpretability.Results: A total of 5681 elderly Chinese were included in the development data and 12,373 in the external validation data. CGD-Risk showed good discrimination during internal validation (C: 0.81, 95 % CI 0.79 to 0.84) and external validation (C: 0.77, 95 % CI: 0.76, 0.78). Compared to an alternative screening strategy CGD-Risk would correctly identify 17.8 more elderly with depression per 100 people screened. Limitations: We were only able to externally validate a partial version of CGD-Risk due to differences between the internal and external validation data.Conclusions: CGD-Risk is a clinically viable, minimally sensitive screening tool that could identify elderly Chinese at high risk of depression while circumventing issues of response bias from stigma surrounding emotional openness.

Automated summary

The study developed and externally validated the Chinese Geriatric Depression Risk calculator (CGD-Risk) using nationally representative survey data. The model showed good discrimination in identifying elderly Chinese at high risk of depression, while also addressing issues related to stigma surrounding emotional openness.